reconstruction mandibula 2.ppt
DESCRIPTION
RECONSTRUCTION MAndibulaTRANSCRIPT
MANDIBULAR RECONSTRUCTIONMANDIBULAR RECONSTRUCTION
Literature ReadingLiterature ReadingFriday, March, 19th, 2004
Fari Ananda
Dept of Otorhinolaryngology – Head & Neck Dept of Otorhinolaryngology – Head & Neck SurgerySurgery
Padjadjaran UniversityPadjadjaran UniversityHasan Sadikin General HospitalHasan Sadikin General Hospital
BandungBandung, 2004, 2004
19/03/200419/03/2004 LR / FALR / FA 22
Mandibular reconstruction of segmental defects Mandibular reconstruction of segmental defects is important procedure after is important procedure after trauma or trauma or following ablative procedures for oral following ablative procedures for oral malignancies malignancies
Function of the Mandible :Function of the Mandible : Protection of the airwayProtection of the airway Support of the tongue & musculatureSupport of the tongue & musculature Anchorage of the lower dentitionAnchorage of the lower dentition Appearance of the lower third of the faceAppearance of the lower third of the face Facial cosmeticFacial cosmetic
19/03/200419/03/2004 LR / FALR / FA 33
Interrupting the continuity of the mandible Interrupting the continuity of the mandible invariably produces a cosmetic and functional invariably produces a cosmetic and functional deformity.deformity.
The dysfunction may vary from minimal, as in The dysfunction may vary from minimal, as in thethe case of lateral defects with negligible loss case of lateral defects with negligible loss ofof tongue function, to major when more tongue function, to major when more extensive, combined soft- and hard-tissue extensive, combined soft- and hard-tissue losses are losses are incurred. incurred.
19/03/200419/03/2004 LR / FALR / FA 44
The major causes of mandibular discontinuity :The major causes of mandibular discontinuity :
Tumor resectionTumor resection Loss from traumaLoss from trauma Unsuccessful healing of mandibular fractureUnsuccessful healing of mandibular fracture Osteonecrosis following radiation therapyOsteonecrosis following radiation therapy Atrophy due aging and dimeneralizationAtrophy due aging and dimeneralization
19/03/200419/03/2004 LR / FALR / FA 55
The ultimate goal The ultimate goal reconstruction reconstruction is to restore is to restore the patient to the pre-disease statethe patient to the pre-disease state
Goals of primary oromandibular Goals of primary oromandibular reconstructionreconstruction Restore mandibular continuityRestore mandibular continuity Restore lower facial contourRestore lower facial contour Maintain mobility of residual tongueMaintain mobility of residual tongue Rehabilitate with a functional lower dentureRehabilitate with a functional lower denture Improve mastication, deglutition and speechImprove mastication, deglutition and speech Restore sensation to denervated lower lipRestore sensation to denervated lower lip Restore sensation to resurfaced portions of Restore sensation to resurfaced portions of
oraloral cavitycavity
19/03/200419/03/2004 LR / FALR / FA 66
19/03/200419/03/2004 LR / FALR / FA 77
19/03/200419/03/2004 LR / FALR / FA 88
19/03/200419/03/2004 LR / FALR / FA 99
Inferior Alveolar nerve Inferior Alveolar nerve teethteeth
Lingual nerve Lingual nerve lingual lingual gingivagingiva
Mylohyoid nerve Mylohyoid nerve mylohyoid musclemylohyoid muscle
Buccal branch Buccal branch buccal buccal gingivagingiva
One branch exits for One branch exits for mental mental sensory for sensory for lower lip and labial lower lip and labial gingivagingiva
Auriculotemporal and Auriculotemporal and messeter nerve messeter nerve TMJ TMJ
Main blood suply Main blood suply Inferior Inferior alveolar branch of the alveolar branch of the internal maxillary arteryinternal maxillary artery
Blood suply for TMJ Blood suply for TMJ Several branches of the Several branches of the
external carotid artery :external carotid artery :
Ascending pharyngeal Ascending pharyngeal arteryartery
Superficial temporal arterySuperficial temporal artery
Middle meningeal arteryMiddle meningeal artery
Anterior tympanic branches Anterior tympanic branches of the internal maxillary of the internal maxillary arteryartery
Classification of Dental Occlusion
Normal OcclusionNeurtocclusion
RetrocclusionRetrusive bite
MesioocclusionProtrusive bite
1212
Planning for reconstructive procedurePlanning for reconstructive procedure
Often the defect is composed of both softOften the defect is composed of both soft - - and hard-tissue componentsand hard-tissue components
History of rHistory of radiation therapy and surgical adiation therapy and surgical scarringscarring
EEvaluation of the patient to define the full valuation of the patient to define the full extent of extent of the bony and soft-tissue componentsthe bony and soft-tissue components
Clinical examination Clinical examination
Radiographic evaluationRadiographic evaluation
Hyperbaric oxygen therapyHyperbaric oxygen therapy
Timing ReconstructionTiming Reconstruction
19/03/200419/03/2004 LR / FALR / FA 1313
The topography of mandibular discontinuity defects
A lateral defect limited to the body very often causes minimal cosmetic/functional deformities
Acquired laterognathia Some patients can compensate quite well
Bony defects that extend to the ramus presence of a proximal segment and a functional TMJ and condylar neck
Extirpative oncologic procedures of tumors Andy Gump deformities
19/03/200419/03/2004 LR / FALR / FA 1414
41 %
23 %
5 %
18%0,4%
3%
9%
19/03/200419/03/2004 LR / FALR / FA 1515
19/03/200419/03/2004 LR / FALR / FA 1616
19/03/200419/03/2004 LR / FALR / FA 1717
Complete Disarticulation Oblique
Subcondylar Osteotomy
Horizontal Osteotomy Above Lingula
19/03/200419/03/2004 LR / FALR / FA 1818
Andy Gump DeformityAndy Gump Deformity
19/03/200419/03/2004 LR / FALR / FA 1919
The quality and quantity of the soft-tissue bedThe quality and quantity of the soft-tissue bed
The ideal soft-tissue bed The ideal soft-tissue bed E Enough bulk, nough bulk, vascularity, fibroblasts, and pluripotential cellsvascularity, fibroblasts, and pluripotential cells
Some of the reasons for graft failure Some of the reasons for graft failure mucosal mucosal dehiscence, graft infection leading to complete dehiscence, graft infection leading to complete loss of the transplanted bone, and late graft loss of the transplanted bone, and late graft resorptionresorption
Graft resorption Graft resorption hypocellularity of the recipient hypocellularity of the recipient bedbed
TThe use of hyperbaric oxygen tends to reverse the he use of hyperbaric oxygen tends to reverse the hypocellularity, hypovascularity, and hypoxia hypocellularity, hypovascularity, and hypoxia
19/03/200419/03/2004 LR / FALR / FA 2020
Marx and AmesMarx and Ames
AA greater cellular matrix of viable fibroblasts and greater cellular matrix of viable fibroblasts and neo-angiogenesis is achievedneo-angiogenesis is achieved e enhances the nhances the level of perfusion level of perfusion heal and support the heal and support the transplantation of the nonvascularized bone grafttransplantation of the nonvascularized bone graft
Phase I Phase I Lag phaseLag phase
Phase II Phase II Rapid Rapid ResponseResponse
Phase III Phase III Plateu phasePlateu phase
19/03/200419/03/2004 LR / FALR / FA 2121
There are no absolutly rulesThere are no absolutly rulesBased on the location of the mandibular Based on the location of the mandibular defectdefect
ImmediateImmediate Resection secondary to Resection secondary to
benign tumorbenign tumor
Reconstruction of a Reconstruction of a failed mandibular failed mandibular repairrepair
Gun shot wounGun shot woun
DelayedDelayed
Malignant tumor Malignant tumor excisionexcision
Possible local tumor Possible local tumor reccurancereccurance
Post radiotherapyPost radiotherapy
Options in Options in MMandibular andibular RReconstructioneconstruction
AlloplastsAlloplasts Kirschner wire Kirschner wire Steinmann pin Steinmann pin Preformed appliances Preformed appliances
Silastic Silastic Acrylic Acrylic Fluoroethylene (Teflon) Fluoroethylene (Teflon) Titanium tray Titanium tray Vitallium (chromium-Vitallium (chromium-cobalt) tray cobalt) tray Polyurethane and Polyurethane and Dacron mesh Dacron mesh
Free bone graftsFree bone grafts Autogenous Autogenous
Cortical Cortical Cancellous Cancellous Corticocancellous chips Corticocancellous chips
Allogeneic Allogeneic Cancellous Cancellous Corticocancellous Corticocancellous Biodegradable cribs Biodegradable cribs (rib, ilium, mandible) (rib, ilium, mandible)
Combination graftsCombination grafts (allogeneic cribs filled (allogeneic cribs filled with with particulate autogenous particulate autogenous bone) bone) PBCM PBCM
19/03/200419/03/2004 LR / FALR / FA 2323
Pedicle flaps Pedicle flaps Rib/pectoralis major Rib/pectoralis major Rib/latissimus major Rib/latissimus major Scapula/trapezius Scapula/trapezius Clavicle/Clavicle/sternocleidomastoid sternocleidomastoid Calvarum/Calvarum/temporalis temporalis
Free flapsFree flaps Rib Rib Scapula Scapula Fibula Fibula Ilium Ilium Radius Radius Ulna Ulna Humerus Humerus Metatarsus Metatarsus
Options in Options in MMandibular andibular RReconstructioneconstruction
19/03/200419/03/2004 LR / FALR / FA 2424
Bone formationBone formation Endochondral and Endochondral and membranousmembranous
Factors that influence of healing Factors that influence of healing Age, Age, Vascularized soft tissue, avoidance of Vascularized soft tissue, avoidance of contamination, degree of injury, bone contamination, degree of injury, bone fragments, complete immobilizationfragments, complete immobilization
Bone healing cellsBone healing cells osteoblast, osteoclast and osteoblast, osteoclast and osteocyteosteocyte
3 phases of bone healing3 phases of bone healing Immediate reactionImmediate reaction ReparationReparation RemodelingRemodeling
19/03/200419/03/2004 LR / FALR / FA 2525
Immediate PhaseImmediate Phase
Hematoma formationHematoma formation
InflammationInflammation
Cells inductionCells induction
ReparationReparation
Primary bone healing Primary bone healing Close defect, normal Close defect, normal bone remodelling with rigid fixation, no bone remodelling with rigid fixation, no external callus, type I collagenexternal callus, type I collagen
Secondary bone healing Secondary bone healing Gap exists in Gap exists in fracture fragment, no rigid fixation, callus fracture fragment, no rigid fixation, callus formationformation
2626
Early stage similar with healing but later stage differEarly stage similar with healing but later stage differAxhausen`s Axhausen`s two phase theory of osteogenesis two phase theory of osteogenesis
Phase IPhase I Start early after grafting , continues for the first 4 Start early after grafting , continues for the first 4 weeksweeksUltimate size of the bone graftUltimate size of the bone graft
Phase IIPhase IIBegins at 2 weeks, peaks 4 weeks, slowly 6 weeksBegins at 2 weeks, peaks 4 weeks, slowly 6 weeksTransformation of pluripotential host cells onto Transformation of pluripotential host cells onto osteoblastic cellsosteoblastic cellsRemodeling of phase IRemodeling of phase IHost fibroblast growth into graft mediated by BMPHost fibroblast growth into graft mediated by BMP
Total lossTotal loss host tissue cannot support the graft host tissue cannot support the graft
19/03/200419/03/2004 LR / FALR / FA 2727
Particulate Bone/Cancellous MarrowParticulate Bone/Cancellous Marrow The best osteogenic potential free bone graftsThe best osteogenic potential free bone graftsProvide sufficient amount osteoblast to support Provide sufficient amount osteoblast to support both phases both phases Lacks structural integrity and requires a carrier Lacks structural integrity and requires a carrier such as alloplastic or allogenic cribssuch as alloplastic or allogenic cribs
3 tipe allogeneic cribs3 tipe allogeneic cribs Allogenic mandiblesAllogenic mandiblesAllogenic ribsAllogenic ribsAllogenic iliac boneAllogenic iliac bone
19/03/200419/03/2004 LR / FALR / FA 2828
IdeallyIdeally similar similar morphologymorphology
Reconstructing ramus or Reconstructing ramus or TMJTMJ
Hollowed out to form crib, Hollowed out to form crib, adapted to remaining adapted to remaining fenestrated to facilitate fenestrated to facilitate host tissue ingrowth host tissue ingrowth fixed with screw fixed with screw packed with PBCMpacked with PBCM
19/03/200419/03/2004 LR / FALR / FA 2929
Rib is split longitudinally and the 2 cortical Rib is split longitudinally and the 2 cortical strips are then contoured to the surgical strips are then contoured to the surgical defectdefect
19/03/200419/03/2004 LR / FALR / FA 3030
For large defectFor large defect
19/03/200419/03/2004 LR / FALR / FA 3131
19/03/200419/03/2004 LR / FALR / FA 3232
Several cutaneous and myocutaneous flaps are Several cutaneous and myocutaneous flaps are available for use in the closure of soft-tissue available for use in the closure of soft-tissue defects of the oral cavity defects of the oral cavity
Cutaneous flapsCutaneous flaps Forehead Forehead Deltopectoral Deltopectoral Nape of neck Nape of neck
Muscle/musculocutaneous Muscle/musculocutaneous flapsflaps Pectoralis major Pectoralis major Trapezius Trapezius Latissimus dorsi Latissimus dorsi Sternocleidomastoid Sternocleidomastoid TemporalisTemporalis
19/03/200419/03/2004 LR / FALR / FA 3333
Vascularized bone, transferred as either a Vascularized bone, transferred as either a regional flap or a microvascular free flap, regional flap or a microvascular free flap, resists infection and extrusion.resists infection and extrusion.
Its independent blood supply allows it to heal Its independent blood supply allows it to heal rapidly and to become incorporated to the rapidly and to become incorporated to the remaining mandible, regardless of the quality remaining mandible, regardless of the quality of the vascularity in the surrounding recipient of the vascularity in the surrounding recipient bed.bed.
3434
Donor sites for vascularized bone-containing free flaps
Limitations in the use of regional flapsLimitations in the use of regional flaps The stock of The stock of bone is inadequatebone is inadequate
TThe introduction of free flap transfers he introduction of free flap transfers t the he vascularity to the bonevascularity to the bone was usually greater than the was usually greater than the regional flapsregional flaps
Bone Vascular pedicle
Ilium Deep circumflex iliac arteryScapula Subscapular arteryFibula Peroneal arteryRadius Radial arteryUlna Ulnar arteryHumerus Profunda brachii arteryMetatarsus Dorsalis pedis arteryRib Intercostal artery
3535
Ideal qualities for the Ideal qualities for the osseous component osseous component of a composite free of a composite free flapflap
Well vascularized Well vascularized Sufficient length, Sufficient length,
width, height width, height Natural contour Natural contour
simulates shape of simulates shape of mandible mandible
Minimal morbidity Minimal morbidity Accessible for two-Accessible for two-
team approach team approach
Ideal qualities for Ideal qualities for the soft-tissue the soft-tissue component of a component of a composite free flap composite free flap
Well vascularized Well vascularized Thin and pliable Thin and pliable Mobile relative to Mobile relative to
bone bone Sensate Sensate Lubricated Lubricated Minimal morbidity Minimal morbidity Accessible for two-Accessible for two-
team approach team approach
19/03/200419/03/2004 LR / FALR / FA 3636
Implants have been used as Implants have been used as spacersspacers and/or for the internal and/or for the internal fixationfixation and stabilization and stabilization of of bone graftsbone grafts and mandible and mandible
19/03/200419/03/2004 LR / FALR / FA 3737
Soft monofilament steel wire 0.35, 0.4, 0,5 mmSoft monofilament steel wire 0.35, 0.4, 0,5 mmStabilization wiring :Stabilization wiring :
Horizontal wiring Horizontal wiring Simple ligation, Essig & Simple ligation, Essig & Risdon wiringRisdon wiring Intermaxillary fixation Intermaxillary fixation Direct dental wiring, Direct dental wiring,
Noncontinuous, Continuous wiring, Noncontinuous, Continuous wiring, Circummandibular wiringCircummandibular wiring
Fixation Wiring :Fixation Wiring : Direct osseous Direct osseous 2 hole, 4 hole figure of 8, 2 2 hole, 4 hole figure of 8, 2 hole hole figure of 8figure of 8 Transosseous wiringTransosseous wiring
19/03/200419/03/2004 LR / FALR / FA 3838
Risdon Horizontal WiringRisdon Horizontal Wiring
CircummandibuCircummandibular Wiringlar Wiring
19/03/200419/03/2004 LR / FALR / FA 3939
Non Continuous WiringNon Continuous Wiring
Continuous WiringContinuous Wiring
19/03/200419/03/2004 LR / FALR / FA 4040
TransosseousTransosseous
Direct Osesseous
LR / FALR / FA 4141
Splints offer a number of approach to IMFSplints offer a number of approach to IMF
May be made of wire, arch bars or plasticsMay be made of wire, arch bars or plastics
19/03/200419/03/2004 LR / FALR / FA 4242
Metal Metal SplintsSplints
19/03/200419/03/2004 LR / FALR / FA 4343
Screw is used to Screw is used to stabilize lamellar stabilize lamellar fracturefracture
V 4 AS steels screws V 4 AS steels screws 2.0 – 2.7 mm 2.0 – 2.7 mm
Interfragmental Interfragmental compressionscompressions
Drilling process is a Drilling process is a critical partcritical part
Complication Complication Loosening of bone Loosening of bone screwscrew
4444
For all types of fractureFor all types of fracture
Rigid internal fixationRigid internal fixation
Four types of appliances of internal fixationFour types of appliances of internal fixation
Dynamic compression plateDynamic compression plate
Eccentric dynamic plateEccentric dynamic plate
Reconstruction plate/Mandibular bridging Reconstruction plate/Mandibular bridging plateplate
Lag ScrewsLag Screws
High stability defectHigh stability defect compression plate, compression plate, splinting or combinationsplinting or combination
Anatomic reconstructionAnatomic reconstruction small/large small/large compression plate, stabilization platecompression plate, stabilization plate
19/03/200419/03/2004 LR / FALR / FA 4545
Indication for RIFIndication for RIF Contraindicated for IMFContraindicated for IMF Special need for mandibular rigiditySpecial need for mandibular rigidity Special need for access to oral cavitySpecial need for access to oral cavity Prolonged fixationProlonged fixation
Contrandication for RIFContrandication for RIF Simple fracturesSimple fractures Insufficient bone tu support hardwareInsufficient bone tu support hardware Extensively comminuted fractureExtensively comminuted fracture Major loss of boneMajor loss of bone
19/03/200419/03/2004 LR / FALR / FA 4646
Advantages for RIFAdvantages for RIF More comfortable during healing processMore comfortable during healing process Good nutritionGood nutrition Oral hygiene easily maintainedOral hygiene easily maintained No compromise in oral airwayNo compromise in oral airway Lower rates of infectionLower rates of infection
DisadvantagesDisadvantages Need for wide exposure Need for wide exposure Longer incision Longer incision Large amount of implanted foreign materialLarge amount of implanted foreign material Longer operating and timesLonger operating and times Expensive and higher complicationExpensive and higher complication
4747
Pressing the bone Pressing the bone fragments tightly fragments tightly together and creating together and creating high degree of high degree of stabilitystability
Spherical gliding Spherical gliding principleprinciple
Classic design for 4 hole Classic design for 4 hole compression platecompression plate
19/03/200419/03/2004 LR / FALR / FA 4848
Overcountoring a compression plate by 3 to 5 degrees
19/03/200419/03/2004 LR / FALR / FA 4949
For segmental, For segmental, comminuted comminuted fractures and fractures and fractures of the fractures of the atrophic senile atrophic senile mandiblemandible
Usually function as a Usually function as a monocortical monocortical retention plate retention plate
Satisfied for Satisfied for treatment of treatment of pediatric fracturespediatric fractures
19/03/200419/03/2004 LR / FALR / FA 5050
IndicationIndication Long term stabilizationLong term stabilization Maintenance space and spatial relationshipsMaintenance space and spatial relationships Contraindicated for IMFContraindicated for IMF
AdvantagesAdvantages Relatively rigid immobilizationRelatively rigid immobilization Exact spatial relationships may be maintainedExact spatial relationships may be maintained Lack of instruments ang foreign body implantation Lack of instruments ang foreign body implantation
on fracture siteon fracture site
DisadvantagesDisadvantages Not cosmeticallyNot cosmetically Scars are produced at pin punctureScars are produced at pin puncture Bone infection and requires special equipmentBone infection and requires special equipment
19/03/200419/03/2004 LR / FALR / FA 5151
19/03/200419/03/2004 LR / FALR / FA 5252
Refers to surgical procedure that cut into or Refers to surgical procedure that cut into or through the mandiblethrough the mandible
Gaining access to deeper structures, removing Gaining access to deeper structures, removing diseased tissue adjacent to mandible, diseased tissue adjacent to mandible, preserving maximum mandibular function preserving maximum mandibular function and facial appearanceand facial appearance
Is also a valuable technique for mandibular Is also a valuable technique for mandibular mobilization and repositioning to correct mobilization and repositioning to correct traumatic and congenital deformitiestraumatic and congenital deformities
19/03/200419/03/2004 5353
Approach for anterior Approach for anterior and posterior oral cavityand posterior oral cavity
19/03/200419/03/2004 LR / FALR / FA 5454
Approach to posterior, near the junction Approach to posterior, near the junction of the posterior body and the angle of the posterior body and the angle mandiblemandible
19/03/200419/03/2004 LR / FALR / FA 5555
Adequate acess to mid Adequate acess to mid and posterior oral and posterior oral cavity, tonsil, cavity, tonsil, oropharynxoropharynx
Avoiding injury and Avoiding injury and transection of the transection of the genioglossus, genioglossus, genihyoid and genihyoid and digastric muscledigastric muscle
Preserves the sensory Preserves the sensory innervation of the innervation of the lower lip and chinlower lip and chin
5656
Problem Problem after oromandibular reconstructionafter oromandibular reconstruction loss of loss of sensation sensation in in larger areas of oral and pharyngeal larger areas of oral and pharyngeal mucosamucosa
OOral cavityral cavity food trapping, disturbed oral hygienefood trapping, disturbed oral hygiene, , mastication problemsmastication problems, , disturbed deglutition and disturbed deglutition and life-threatening aspirationlife-threatening aspiration
SolutionSolution Sensate soft tissue free flap + Sensate soft tissue free flap + vascularized bone vascularized bone
Donor sitesDonor sites radial forearm, ulnar forearm, lateral radial forearm, ulnar forearm, lateral arm, dorsalis pedis, and rib donor sites provide arm, dorsalis pedis, and rib donor sites provide skin with a sensory nerveskin with a sensory nerve
The use of a separate sensate cutaneous free flap in The use of a separate sensate cutaneous free flap in combination with a vascularized bone free flap combination with a vascularized bone free flap such as the iliac crest or fibulasuch as the iliac crest or fibula
5757
The sensory innervation of the lower lip The sensory innervation of the lower lip restored via nerve grafting between the restored via nerve grafting between the proximal stump of the inferior alveolar nerve proximal stump of the inferior alveolar nerve and distally the mental nerveand distally the mental nerve
The nThe nerve can then be reconstructed using an erve can then be reconstructed using an autogenous nerve graftautogenous nerve graft : : GGreater auricularreater auricular SSuralural nerve nerve AAnterior bracheocutaneousnterior bracheocutaneous nerve nerve LLateral femoral cutaneous nerves ateral femoral cutaneous nerves
19/03/200419/03/2004 LR / FALR / FA 5858
TThree types of dental prostheseshree types of dental prostheses
1. 1. Conventional tissue-borne denturesConventional tissue-borne dentures LLeast stable prosthesiseast stable prosthesis
PPartial restoration if the residual teeth can be usedartial restoration if the residual teeth can be used2. 2. Implant-borne dentureImplant-borne denture
FFixed, retrievableixed, retrievable, , most stable form most stable form
It is useful for one-quadrant restorationIt is useful for one-quadrant restoration
3. 3. Implant-assisted dentureImplant-assisted denture RRemovable prosthesis supported by two or more emovable prosthesis supported by two or more implants implants in the symphyseal regionin the symphyseal region
MMore stable and retentive than conventional ore stable and retentive than conventional dentures dentures and less costly than the implant-borne and less costly than the implant-borne prosthesis.prosthesis.
19/03/200419/03/2004 LR / FALR / FA 5959
Oromandibular reconstruction is a problem of both Oromandibular reconstruction is a problem of both the bone and the soft tissue. The quality and the bone and the soft tissue. The quality and quantity of the soft-tissue bed are criticalquantity of the soft-tissue bed are critical part part
The ultimate goalThe ultimate goal mandibular reconstruction mandibular reconstruction is to is to restore the patient to the pre-disease staterestore the patient to the pre-disease state good mandibular function and appearancegood mandibular function and appearance
There are many option for mandibular There are many option for mandibular reconstruction reconstruction Corticocancellous bone chips Corticocancellous bone chips are advantageous are advantageous they provide the they provide the osteoblasts necessary for bone formation osteoblasts necessary for bone formation promote rapid revascularization. promote rapid revascularization.
19/03/200419/03/2004 LR / FALR / FA 6060
Bone vascularity may be maintained through Bone vascularity may be maintained through regional flaps or composite free flaps.regional flaps or composite free flaps.
VVascularized bone-containing free flapsascularized bone-containing free flaps broadening the surgeon’s ability to restore broadening the surgeon’s ability to restore oral cavity anatomy and functionoral cavity anatomy and function
Sensation Sensation oral cavity and lip oral cavity and lip can be restored can be restored with sensate free flapswith sensate free flaps
6262
Bailey B.J.. Hoult. G. R. Bailey B.J.. Hoult. G. R. Surgery of the Mandible. Surgery of the Mandible. Thieme Thieme Medical Pub, Inc. New YorkMedical Pub, Inc. New York. 19. 1987.87.
Brent.B. Brent.B.P Brent.B. Brent.B.P The Artistry of Reconstructive Surgery. The Artistry of Reconstructive Surgery. Selected Classic Case Studies Selected Classic Case Studies The C.V Mosby CompanyThe C.V Mosby Company. St. . St. Louis. 19Louis. 1987.87.
Butcbinder D.W. Urken M.L. Butcbinder D.W. Urken M.L. Mandibular Reconstruction Mandibular Reconstruction in Byron in Byron J. Bailey Head & Neck Surgery-Otolaryngology. 2nd ed. J. Bailey Head & Neck Surgery-Otolaryngology. 2nd ed. Lippincott-Raven. Philadelphia. 1998Lippincott-Raven. Philadelphia. 1998..
Cumming W C. Frederickson J M. Cumming W C. Frederickson J M. Otolaryngology-Head and Neck Otolaryngology-Head and Neck Surgery.Surgery. 2nd ed. 2nd ed. Mosby Year Book. St. Louis. 1993Mosby Year Book. St. Louis. 1993
Jurkiewicz M.J. Krizek.T.J. Mathes.S.J. Ariyan S. Jurkiewicz M.J. Krizek.T.J. Mathes.S.J. Ariyan S. Plastic Surgery Plastic Surgery Principles and Practice. Principles and Practice. Vol. OneVol. One. . The C.V Mosby CompanyThe C.V Mosby Company. St. . St. Louis. 19Louis. 1990.90.
Nauman, H.H. Tardy.M.E. Kastenbauer. E.R. Nauman, H.H. Tardy.M.E. Kastenbauer. E.R. Face, Nose and Face, Nose and Facial Skull Part III Facial Skull Part III in Head and Neck Surgeryin Head and Neck Surgery Vol.1Vol.1. . Thieme Thieme Medical Pub, Inc. New YorkMedical Pub, Inc. New York. 199. 1995.5.
Papel I.D, Nachlas N.EPapel I.D, Nachlas N.E Facial Plastic and Reconstructive Surgery. Facial Plastic and Reconstructive Surgery. Mosby Year Book. St. Louis. 199Mosby Year Book. St. Louis. 19922